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				<p class="content-title">Organization</p>
				<img class="img-responsive center-block" src="../../img/industry-segments-managed-care/MCO-organizational-chart.png"/>	
				<div class="caption text-center">Figure 3 – Organizational Chart of an MCO.</div></br>

				<ol type="I" class="paragraph">
					<li><strong>Board of Directors/Board Committees</strong></li>					
					<p class="paragraph">Generally, boards have committees that have certain functions. Board committees included may be the following:</p>					
					<ul class="paragraph disc">	
						<li><strong><i>Executive Committee</i></strong></li>						
						<p> Has the direct access to urgent decision making and other confidential matters.</p>
						
						<li><strong><i>Compensation Committee </i></strong></li>						
						<p> Has the responsibility of setting general guidelines for the plan on matters concerning compensation, 
						responsible for setting the CEO’s compensation and does the approval and issuance of stock options.</p>
						
						<li><strong><i>Finance Committee/Audit Committee</i></strong></li>						
						<p> Has the responsibility of approving the budget, reviewing of financial results, setting and approving of 
						individuals that are authorized to spend, reviewing and approving of external sources of funds and reviewing
						of the annual audit.</p>
						
						<li><strong><i>Quality Management (QM) Committee </i></strong></li>						
						<p> Ensures the quality of health care services delivered to the plan members.</p>
						
						<li><strong><i>Corporate Compliance Committee </i></strong></li>						
						<p> Has the responsibility of over-all overseeing of the organization’s compliance requirements.</p>
					</ul>
					
					<li><strong>Key Management Positions of a Plan</strong></li><br/>
					<ol class="paragraph">	
						<li><strong><i>Executive Director/Chief Executive Officer</i></strong></li>
						<ul class="paragraph disc">
							<li>Individual who has the highest authority among all key management positions.</li>
							<li>Regarded as the chief executive officer in an independent health plan.</li>
							<li>Also referred to as the executive director in health plan that is a subsidiary of a larger company.</li>
							<li>Has the responsibility for public affairs and general administrative operations.</li>
						</ul>
						
						<li><strong><i>Medical Director/Chief Medical Officer</i></strong></li>
						<ul class="paragraph disc">
							<li>Can be a physician who reports in a particular number of hours weekly, or can be a full-time manager.</li>
							<li>Sends updates and reports to the CEO in smaller and independent plans, but in the case for regional
							or national companies, reports to another senior officer.</li>
							<li>Has the responsibility in medical policy, Utilization Management (UM) and Quality Management (QM).</li>
							<li>Responsibilities may involve dealing with network maintenance, provider relations and provider recruiting.</li>
						</ul>
						
						<li><strong><i>Finance Director/Chief Financial Officer</i></strong></li>
						<ul class="paragraph disc">
							<li>Responsible for supervision of all financial and accounting operations, budget preparation and financial reporting.</li>
							<li>Usually reports to the executive director in most of the smaller plans.</li>
							<li>Has the ultimate responsibility for all financial reporting or management in larger plans and other national companies.</li>
							<li>Heads the following defined areas with the respective leaders:</li>
								<ul class="paragraph">
									<li><strong><i>Operational Finance</i></strong> - manages and monitors the daily financial status, budget 
									process, reporting and the like.</li>
									<li><strong><i>Treasury</i></strong> - manages finances and the flow of money in and out of the company, 
									as well as risk-based capital.</li>
									<li><strong><i>Investment of Portfolio Management</i></strong> - manages the plan’s investments.</li>
									<li><strong><i>Internal Audit</i></strong> - ensures that the group’s function adhere to the proper internal financial 
									controls and to certain laws and regulations.</li>
								</ul>
						</ul>
						
						<li><strong><i>Medical Advisory Committee</i></strong></li><br/>
						<ul class="paragraph disc">
							<li>Responsible in reviewing general medical management issues as raised by the medical director.</li>
							<li>Issues handled could be changes in authorization and management procedures, compensation and modifications in 
							the contract with providers.</li>
						</ul>
						
						<li><strong><i>Denial of Coverage Appeal Committee</i></strong></li>
						<ul class="paragraph disc">
							<li>Typically composed of specialists.</li>
							<li>Reviews appeals on issues related to the denial of the coverage of health care plans.</li>
							<li>Members are required to attend meetings only if the type of appeal being reviewed is related to their specialty.</li>
						</ul>
						
						<li><strong><i>Pharmacy and Therapeutics Committee</i></strong></li>
						<ul class="paragraph disc">
							<li>Composed of pharmacists and specialists.</li>
							<li>Usually does the review for any unusual prescription utilization pattern given by the health care service providers.</li>
							<li>Also responsible for the recommendation for local or pan-specific modifications to the over-all formulary.</li>
						</ul>
					</ol>
					
					<li><strong>Medical Management Committees</strong></li>				
					<p class="paragraph">Medical committees are concerned with the functional activities rather than governance as exhibited by the committees of the board.</p>					
					<ol class="paragraph disc">	
						<li><strong><i>Credentialing Committee</i></strong></li>						
						<ul class="paragraph">
							<li>Has the responsibility to review the providers’ ability to cover the plan’s standards for participation.</li>
							<li>Sets the standards for the plans.</li>
						</ul>
						
						<li><strong><i>Quality Management Committee</i></strong></li>						
						<ul class="paragraph disc">
							<li>Oversees the Quality Management (QM) activity, review of data, follow-up, setting of standards, feedback to providers
							and approval of sanctions.</li>
						</ul>
						
						<li><strong><i>Peer Review Committee</i></strong></li>						
						<ul class="paragraph disc">
							<li>Responsible in reviewing complaints or concerns about problematic utilization behaviour of particular participating 
							physicians brought to attention by the medical managers of the plan.</li>
						</ul>
						
						<li><strong><i>Medical Advisory Committee</i></strong></li>						
						<ul class="paragraph disc">
							<li>Responsible in reviewing general medical management issues as raised by the medical director.</li>
							<li>Issues handled could be changes in authorization and management procedures, compensation and modifications in the contract with providers.</li>
						</ul>
						
						<li><strong><i>Denial of Coverage Appeal Committee</i></strong></li>						
						<ul class="paragraph disc">
							<li>Typically composed of specialists.</li>
							<li>Reviews appeals on issues related to the denial of the coverage of health care plans.</li>
							<li>Members are required to attend meetings only if the type of appeal being reviewed is related to their specialty.</li>
						</ul>
						
						<li><strong><i>Pharmacy and Therapeutics Committee</i></strong></li>						
						<ul class="paragraph disc">
							<li>Composed of pharmacists and specialists.</li>
							<li>Usually does the review for any unusual prescription utilization pattern given by the health care service providers.</li>
							<li> Also responsible for the recommendation for local or pan-specific modifications to the over-all formulary.</li>
						</ul>
					</ol>
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